Spinal Program | Expansion Thoracostomy

What is the Titanium Rib (VEPTR™)?

VEPTR™, which stands for Vertical Expandable Prosthetic Titanium Rib, is sometimes referred to as the Titanium Rib. It is used to treat thoracic insufficiency syndrome.

Natural ribs run horizontally along the chest, while the Titanium Rib is used vertically. After an expansion thoracostomy operation to enlarge the chest, the Titanium Rib is placed vertically between the ribs to keep the chest wall expanded. Made out of a metal rod curved to fit the back of the chest and spine, the device helps the spine to become straighter and allows the lungs to grow and to fill with enough air to breathe. The device can be made longer as your child grows. 

VEPTR Device

History of the Titanium Rib Project

The VEPTR™ device was developed at the Christus Santa Rosa Children's Hospital in San Antonio, Texas, by Robert Campbell, MD, and Melvin Smith, MD. The device is indicated for treatment of Thoracic Insufficiency Syndrome in skeletally immature patients. In 1998, Boston Children's Hospital was selected as a site for the first extensive VEPTR use outside San Antonio. 

What is Thoracic Insufficiency Syndrome?

Thoracic insufficiency syndrome is a term used in connection with the Titanium Rib and VEPTR devices. It refers to the chest's inability to support normal growth of the lungs or spine. The normal chest provides space for the growing lungs and partial support for the growing spine.

Both lung growth and function as well as spine growth can be affected by various conditions such as congenital chest wall and spinal abnormalities, acquired surgical chest wall problems and inherited or genetic bone dysplasia with abnormally small chests. These conditions, which might be helped by expansion thoracostomy and VEPTR insertion, are categorized as thoracic insufficiency syndrome. 

What is an Expansion Thoracostomy and VEPTR Insertion?

Expansion thoracostomy and insertion of one or more VEPTR devices is used for the treatment of thoracic insufficiency syndrome.

The goal of this operation is to make one (or both) sides of the chest larger, longer or more normal in shape. A larger chest can provide more room for the lungs to expand or grow. A larger, longer or straighter chest can help some abnormal spines stay as straight as possible while still allowing for spine growth.

In the expansion thoracostomy operation, one or more separations are made between the ribs, and the ribs are spread apart to make the chest larger. In some expansion thoracostomies, congenitally abnormal or fused ribs are separated, while in others multiple cuts are made in the ribs, or the naturally occurring space between the ribs is opened.

After the expansion thoracostomy procedure, the VEPTR device is attached to the healthy ribs above and below (conventional device), or ribs above and spine below (hybrid device). Often, more than one device is used. For patients with congenitally small chests on both right and left, operations can be performed on both sides but are separated by a long recovery period.

Additional Resources

Testing Their Metal: Titanium rib procedure gives patients room to breathe

VEPTR webcast (replay)